Foreshocks before the big one: Warning signs prior to emergency department visits in patients with advanced cancer.

41 Background: Our analysis evaluated the ASCO Standard B.2, which aims to improve patient outcomes by early intervention to prevent emergency department (ED) visits and hospitalizations. We analyzed patient data to identify high-risk individuals based on frequency and content of calls to the clinic. Methods: A retrospective review was conducted of cancer patients that had ED visits between July-December 2024 utilizing data from Virginia’s Health Information Exchange (HIE); a system that auto-generates reports for real-time ED/IP data. We focused on activity leading up to the ED visit to identify an appropriate time range where interventions could prevent ED visits. The Navigating Care triage ticket system generates reports that categorize calls and prioritizes symptom management responses. Utilizing these reports, we identified patient trends leading up to ED visits. Results: From July to December 2024, 9,122 patients were uploaded into HIE. There were 2,085 ED/Obs visits. 29% (n = 605) called the clinic within 14 days of their ED visit. 58% of these patients called multiple times for symptoms, rescheduling, or medication questions (refills excluded). Additionally, 45% of calls had more than one complaint, averaging 1.25 calls per patient. 90% of symptom calls matched the ED visit diagnosis: pain, fatigue/weakness, nausea/vomiting/diarrhea, urination problems being the dominant symptoms. Conclusions: Patients with two or more calls to the clinic regarding symptoms, rescheduling, or medication questions in a two-week period are at higher risk for ED visits based on findings. Identifying and targeting this high-risk population with more aggressive care planning leads to timely interventions increasing the likelihood of preventing ED visits. 0-4 Days (n=445 calls, n=324 unique patients) 5-14 Days (n=309 calls, n=281 unique patients) Appt reschedule 7% 32% Symptom 31% 28% Medication Question 14% 9% Appt reschedule, Symptom 16% 6% Symptom, Medication Question 13% 2% Appt reschedule, Medication Question 4% 3% Appt reschedule, Symptom, Medication Question 6% 1% Other, not appt reschedule, medication question, symptom 8% 20% 2 or more calls 38% 62%